Guest Editorial: Where is Trump's emergency on opioids?

Amid much fanfare last October, President Trump declared that the nation's opioid crisis was a “public health emergency” and spoke movingly of losing his older brother to alcohol addiction. That 90-day declaration is set to expire Tuesday. And while some promising plans are taking shape, the federal follow-through is falling far short of what is needed.

About 1,000 people in America are dying each week from this epidemic, and the time is long past for the president to mobilize “every appropriate emergency authority,” as he promised on Oct. 26.

Among the missing pieces:

• Key players. Can you name the nation's "drug czar" these days? Probably not, because there isn't one. The Office of National Drug Control Policy, a high-profile White House office that should coordinate a government-wide strategy, still has no permanent director, the person often known as the drug czar.

The office is run by an acting director, after Trump was forced to withdraw his first nominee. In part because the office has so many vacancies, a 24-year-old former campaign worker, with an inflated résumé and no obvious experience in drug policy, recently rose to be the deputy chief of staff.

• More money. While the administration says it has spent or allocated more than $1 billion on the opioid crisis, huge chunks of the funding were provided under laws passed in 2016, before Trump took office.

For example, $485 million distributed last April under what the White House calls “the newly created State Targeted Response to the Opioid Crisis,” was authorized in the 21st Century Cures Act signed by President Obama in December 2016.

That's not exactly the rallying cry for resources one expects in an emergency. Trump’s 2018 budget request to Congress for everything from prevention and treatment to law enforcement called for a paltry 1 percent increase over Obama's last budget for drug control.

• Promised initiatives. Trump promised “really tough, really big, really great advertising” to prevent people from abusing drugs in the first place. Nothing on that yet. Nor is there any noticeable movement on a key part of his Health and Human Services Department's five-point strategy, which touted targeting "the availability and distribution of overdose-reversing drugs.”

Health commissioners in cities and states hardest hit by the opioid scourge were optimistic about the emergency declaration, which some say gave the crisis the national visibility it has long needed. But the federal follow-through? Not so much.

“There has been no effect for those of us on the ground,” says Baltimore Health Commissioner Leana Wen, whose city lost 694 people to overdoses in 2016. One of her biggest needs: more naloxone. Public Health Commissioner Rahul Gupta of West Virginia, which has the highest rate of overdose deaths in the nation, also hoped for a “surge in resources” that has not materialized.